Cancer and End of Life – a Perspective from within the Oncologist-Patient Relationship

In the field of oncology, the terminal phase of cancer patients is difficult to apprehend, both for patients and physicians. To counter this difficulty, the medical literature underlines the importance of introducing palliative care early on in cancer patients’ trajectories (Temel et al., 2010). We conducted a 3-year study alongside cancer patients and physicians to examine their trajectories, in particular this end of life stage. We conducted semi-structured interviews, engaged in participant observation, led a sociological intervention (Touraine, 1978 ; Joly, 2016). Our objective was to understand how cancer patients and physicians, but also nurses, cope with the cancer pathology, from diagnosis to death. Talking about end of life with patients proved difficult ; their hope, at all stages of cancer, was to live, to recover. We did not encounter obstacles when discussing end of life with doctors and nurses, although they also underscored the complexity of articulating hope and (more or less) impending death in their care of patients. In this presentation, we will focus on one particular aspect of the research : the consultation with the oncologist. We observed oncologists’ consultations for 18 months in hospital settings. As such, we were privy to the developing patient-physician relationship. We will show how death is rarely discussed in a direct manner, although it underpins every consultation, even those with patients in remission. We will also underline how end of life is most often apprehended by way of considering logistics of care (where a patient will be transfered, under what circumstances, etc.), and how oncology care led by two physicians (an oncologist and palliative/pain specialist) from the onset can – sometimes – facilitate the discussion about end of life between patients and doctors.